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Older people are wrongly excluded from drug trials

BMJ 2005; 331 doi: (Published 08 December 2005) Cite this as: BMJ 2005;331:1360
  1. Christiane Rehwagen
  1. BMJ

    Age discrimination exists in many aspects of elderly people's health care, a conference in London heard last week. Peter Crome, professor of geriatric medicine at Keele University and president elect of the British Geriatrics Society, was speaking at a conference on medication for frail older people organised by CCC, a group representing commercial, charitable, and public service organisations in London.

    “The [National Service Framework] for older people is clearly against discrimination on the grounds of age, but there are many examples which show a different reality.” Professor Crome explained. The common imposition of upper age limits for clinical trials was an important form of discrimination, he said.

    “Frail older people show differences in their response to drugs. It is important that trials on drugs often used in older people are also performed in the [relevant] age group.” When trials were performed in people older than 80 they mostly looked at the risks and not the benefits, he added.

    Thierry Nebout, senior consultant in medical sciences to the president of research and development at Servier, a pharmaceutical company, said: “There aren't enough financial incentives for drug companies to do research in older people. Charities and regulation need to make this to change.”

    Another problem is that some drugs that are known to be effective are underused in elderly people and others are wrongly used. “Recent UK research indicates that inappropriate neuroleptic prescribing in nursing homes continues to be an issue,” said Professor Crome.

    Gillian Dalley, chief executive of the Relatives and Residents Association, said, “The next concern is polypharmacy. Thirty eight per cent of people over 75 take four or more drugs daily. At the same time, fewer than a third of GPs have procedures in place for regular medication review as required in the [National Service Framework. An estimated] 6.5% of [emergency] admissions are due to adverse incidents mainly in older people.”

    Ralph Greenwall, senior pharmacist at Bradford City Primary Care Trust, considered the issue of how to explain to elderly people all the relevant details about drugs. “Everybody who is involved with medication in elderly people is responsible for it.

    “First, it happens too often that clinical measurements are taken but not acted on. Second, if a patient struggles with a new medication a pharmacy should be involved. Dosage aids and large labels can already help a lot.”

    The conference was also told that better end of life care for older adults is an urgent issue. Eve Richardson, chief executive of the National Council for Palliative Care, said, “In 2004, 51% of deaths were [in people] over 80.” That mean increasing numbers were dying with dementia. “They are often excluded from good palliative and end of life care by reason of diagnosis.”

    She added, “To improve end of life care in older people, the Gold Standards Framework, the Liverpool Care Pathway, and the Preferred Place of Care tools recommended in the [National Institute for Health and Clinical Excellence] guidance on palliative care should be used more frequently by generalists.”

    See Including older people in clinical research (BMJ 2005;331:1036-1037, 5 November) and Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits (BMJ2005;331:1169, 19 November)

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